Active NPI
Eva Simone Wilson, PHD
- Counseling Psychologist
- New Haven, CT
National Provider Identifier
1477001139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 4299
- Practice address
- 55 Lock St
New Haven, CT 06511-3603 - Phone
- (203) 432-0290
- NPI assigned
- Sep 12, 2016
- Last updated
- Oct 14, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 4299 | CT | Primary |
Addresses
Primary practice location
55 Lock St
New Haven, CT 06511-3603
Mailing address
55 Lock St
New Haven, CT 06511-3603
Phone (203) 432-6110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4299 | CT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665705600000",
"number": "1477001139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 LOCK ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065113603",
"telephone_number": "203-432-6110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LOCK ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065113603",
"telephone_number": "203-432-0290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "EVA",
"middle_name": "SIMONE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-12",
"last_updated": "2022-10-14",
"certification_date": "2022-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "CT",
"license": "4299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.